SLEEP

Sleep problems are very common in preschool children. Not a week goes by that I don’t get a letter from parents who want their children to go to sleep at a reasonable time in their own bed and sleep through the night so the parents can get a night’s sleep.

Both bedtime struggles and night awakening are very common in these children and often occur together. At least a quarter of children this age resist going to bed. Young children do not want to go to sleep because of age-related unwillingness to separate from people or activities.

Parents, out of love and enchantment (it’s pleasurable to be truly wanted by such an adorable creature) reinforce the child’s behavior by allowing prolongation of the bedtime separation. But somewhere along the line parents start to resent the child’s behavior and realize the child is avoiding going to bed out of desire, not need.

The International Classification of Sleep Disorders has a name for serious bedtime struggles: Limit-Setting Sleep Disorder. It starts with a perfectly normal developmental resistance to bedtime, but escalates into a real problem because the parents are inconsistent in setting limits and/or unable to separate from their distressed child. These are conscientious, loving parents who want to do the right thing and think the right thing is to keep their child happy at all times.

Bedtime struggles usually escalate BECAUSE OF PARENTAL BEHAVIOR. The child screams louder when the parent tries to leave the room or the child leaves the bedroom for still another glass of water or trip to the bathroom. The parents get angry — and tired — and attempt to apply rules. The protest gets louder and the parents can’t stand it any longer so they go back in the room, or let the child stay with them until sleep occurs, or punish the child, or go from one response to the other until the child has no idea what to expect. Sometimes one parent gives in and the other applies the rules which adds to the child’s confusion and foments marital discord.

Night waking and demands to go into the parents’ bed are both common in preschoolers — parents report as many as a third of children do this. Such behaviors may be puzzling to parents when they occur in a child who has previously slept through the night. A common cause of night waking is that the child associates the parent’s presence with falling asleep. This is usually correlated with parents allowing children to fall asleep in their arms or co-sleeping or prolongation of night feedings.

In addition to parental failure to set limits, some child factors can contribute to prolonged bedtime struggles. Some children are “irregular” in their temperament and have difficulty with schedules. Some children need less sleep than the parents expect. Often, preschoolers become frightened by dreams and avoid sleep to avoid being scared.

Prevention is the best route. We now know that babies should be allowed to fall asleep in their own cribs in order to learn how to self-calm and develop their own sleep associations. We know children do better if their parents believe in and keep reasonable schedules for meals and bedtimes.

What to do if you have a sleep problem in your preschooler now? The first step is for the parents to read a bit about sleep and sleep disorders in children (the classic is Solving Your Child’s Sleep Problems, by Richard Ferber, which you can find in the library), understand the role they are playing, and figure out ways to CHANGE THEIR BEHAVIOR without feeling guilty about their past behavior.

Some doctors advise keeping a sleep journal for two weeks in which they keep track of the time the child wakes up, naps, is put to bed, falls asleep, wakes up at night, what you did when child woke up, and the time you went to bed. Sometimes valuable clues are revealed, like the child does better if put to bed earlier or later.

The next step is to decide on a technique, role-play as to what you both will say and do, and resolve to stick to your guns even if it means nobody sleeps for a few nights.

Three techniques that work are:

SYSTEMATIC IGNORING: you let the child scream or fuss.

GRADUATED EXTINCTION: parents respond to crying by briefly returning to the bedroom to reassure the child, and they wait progressively longer before returning. This means you let the child scream before reassurance — perhaps five minutes the first night but maybe 8 or 10 minutes the second night, and

SCHEDULED AWAKENINGS: parents wake the child before the usual night-waking time. Eventually the spontaneous night-wakings disappear.)

Graduated extinction works best in my experience, because it modifies parental behavior, and also reassures the child that you’re still there. Tell the child ahead of time what you are going to do. “Big girls go to sleep at bedtime and stay in their own beds.” Sometimes buying a new bed or redecorating the child’s room is a helpful clue to the child that things are going to change around here. I have no objection to a night light if the child is afraid of the dark.

In summary: parents who are embroiled in bedtime struggles or the night-waking-and-coming-into-our-bed problems should RESEARCH the technique they will use, RESOLVE to follow it consistently no matter how loud the crying, and REPEAT until the problems are solved.

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